Contribution
The hon. Lady is spot on; that is exactly the point that I was getting at. While there is a legal duty in terms of palliation, what that palliation looks like is important. Her question was also raised by the hon. Member for Strangford, who asked whether it is now time to have a strategy dedicated to palliative care, given the rise in demand.
The letter goes on to say:
“Charitable hospices are autonomous organisations that provide a range of services that go beyond that which statutory services are legally required to provide. Consequently, the funding arrangements reflect this.”
We are in a grey area, and a palliative care strategy could well be a way to unlock this problem. I will be interested to hear what the Government have to say on this issue.
However, it is not just about finances and commissioning; it is also about the workforce. That is partly addressed in the letter:
“As set out above, we have committed to develop a ten-year plan to deliver an NHS fit for the future. This summer, we will publish a refreshed NHS long-term workforce plan to deliver the transformed health service we will build over the next decade so that patients can be treated on time again.”
By my calculations, we are coming up to Halloween and even bonfire night, and we still have not seen a workforce plan. My question to the Government is: when are we likely to see that?
That leads me on to my next point: how do the Government intend to ensure that palliative care specialists are included in neighbourhood health centres? The 10-year plan is laudable, and I think there is agreement across the political spectrum on its contents, but the one thing it is missing is a delivery chapter. How are we going to do it? The shift is correct, but we do not know how we are going to get there, so I would be grateful if the Minister could address that. The 10-year plan explicitly talks about public-private partnerships, and there is concern on both sides of the House that we could see PFI mark 2. If Members need to have their memory jogged, private finance initiatives brought in £13 billion to build hospitals and services, but at a cost of £80 billion to taxpayers.
Why does this all matter? In my last few moments, I will turn to the final question that was posed by the hon. Member for Strangford, which was about access to 24-hour support. I will quickly read out a couple of comments from one of my constituents, whose husband Mat sadly passed away from a brain tumour. She highlights this issue:
“During the day, the support was outstanding because I could call the community nurses and the palliative nurses, and they would always call me straight back. They would visit Mat daily to administer the medications needed in his syringe drivers. They were kind, caring and so supportive to us and our family.
The night times were different and frightening. Often during the night when I was trying to get support, he could see how scared and stressed I was, which made him more scared, often telling me he was okay just to try and not make me worry. Every night I used to be thinking what might happen tonight—will Mat have another seizure? Will he be in so much pain again? Will they call me back if I need support? How long will it take to get help to arrive?”
Marie Curie points out that only seven of the 42 ICBs in England have a single point of access. I raised this issue with the Minister in a letter in August, and he kindly responded in September. He pointed out that integrated care boards must commission on this basis. There is NICE guidance on “End of life care for adults”, under quality standard 13, and on “End of life care for adults: service delivery”, under NICE guideline 142, which talks about the fact that there should be some form of 24-hour care, but at no point did the letter address the issue of the phoneline. When I asked the Department about data, I was told in a letter:
“Regarding data about palliative care helplines, such as average waiting/response times, the Department does not collect or hold this information.”
Will the Minister look at that and consider whether the Department should hold such information?
The letter went on to say:
“We recognise that more could be done to support the palliative and end-of-life care sector. I have tasked officials within the Department and at NHS England to look at how improving the access, quality and sustainability of all-age palliative and end-of-life care to ensure that their proposals are in line with the ten-year plan.”
I would be grateful if the Minister could ask the Minister responsible whether there is indeed an update and what that looks like. At the end of the day, we are concerned not necessarily about inputs, but much more about outputs.
We know that death is certain for us all; only our willingness to face it seems optional. This is very much a British mentality, and I believe we need to change that when it comes to talking about death and our mortality. We need to speak more openly and candidly about what an ageing population looks like, for that is what we are. That is why the hon. Member for Strangford brought forward this debate, and he reminds us that we chase the days ahead while never quite noticing how swiftly they turn into years behind us. That leads me to reflect on the fact that, as politicians and as a society, we build a world to live longer, yet we all too easily forget to ask: how do we want to grow old?